141例药物性肝衰竭临床特征及预后分析

Clinical features and prognosis of 141 patients with drug-induced liver failure

目的探讨药物性肝衰竭的病因、临床特征及预后。方法回顾性总结我院2002年1月—2011年4月收治的141例药物性肝衰竭(drug-inducedliverfailure,DILF)的临床资料,分析其药物种类、并发症、预后等相关指标。结果女性发生DILF比例高于男性,发病年龄以青中年为主。急性DILF41例(29.1%),亚急性DILF84例(59.6%),慢性DILF16例(11.3%)。前3位基础疾病是皮肤病、结核病和上呼吸道感染。引起DILF的前4位药物分别是中药、抗生素、解热镇痛药和抗结核药。141例中,治愈21例(14.9%),好转33例(23.4%),无效72例(51.1%),死亡15例(10.6%)。前3位最常见的并发症是胸腹水、电解质紊乱和肝性脑病。影响预后的并发症为肝性脑病、低钠血症、脑水肿、消化道出血、感染性休克和失血性休克。结论 DILF类型以亚急性肝衰竭为主。DILF病死率较高,预后较差。临床应用中药、抗生素、解热镇痛药及抗结核药时,必须定期监测肝功能。

Objective To investigate the etiology, clinical features and prognosis of patient with drug-induced liver failure （DILF）. Methods Clinical data of 141 DILF patients admitted to our hospital from Jan. 2002 to Apr. 2011 were reviewed and drug use, complications and prognosis of those patients were analyzed. Results The female patients with DILF were more than the males. DILF mainly occurred in young and middle-aged persons. Among 141 patients, 41 （29.1%） suffered from acute DILF, 84 （59.6%） subacute DILF and 16 （11.3%） chronic DILF, respectively. The three top underlying diseases were skin disease, tuberculosis and upper respiratory infection. The 4 kinds of drugs causing DILF were herbal medicines, antibiotics, antipyretic and analgesic drugs and anti-tuberculosis drugs. Twenty-one patients （14.9%） were cured, 33 （23.4%） improved, 72 （51.1%） were ineffective and 15 （10.6%） died. The 3 most commonly seen complications were pleural effusion and ascites, electrolyte disorder and hepatic encephalopathy. The complications influencing the prognosis were hepatic encephalopathy, hyponatremia, cerebral edema, alimentary tract hemorrhage, septic shock and hemorrhagic shock. Conclusions The predominant type of DILF is sub-acute liver failure. DILF Patients have high mortality and poor prognosis. Liver function should be monitored when herbal medicines, antibiotics, antipyretic and analgesic drugs or antituberculosis drugs are used in DILF Patients.